First Aid - Head Injuries

Head injury, any damage to the head resulting from piercing the skull or from the brain knocking too fast against the skull. Blood vessels, nerves, and membranes enclosing the brain are torn; bleeding, pooling of fluid, and blockage of blood flow may result. Infection of the brain's enclosing membranes is a serious result that often follows breaking the bones of the cavities behind the nose. Head injury remains a significant cause of death in patients who are victims of multiple trauma (e.g. motor vehicle accidents).

Guidelines for the Head Injured in the First 24 hours

Checkups each hour for "normal" behavior.
Checkups each hour to make sure the patient can be easily awakened.
Observation of the patient's ability to walk or maintain balance.
Observation for nausea and vomiting (dehydration).
Observation of patient's ability to converse normally and move all 4 extremities.

Factors Associated with Serious Head Injury

LOSS OF CONSCIOUSNESS: This may last from 2 to 10 minutes, on average.
AMNESIA: This refers to an inability to remember events prior to or just after the head injury ("How did I get to the hospital?").
SEIZURES: Convulsions after a head injuries are common.
CONFUSION: The patient is not his or her "normal" self. These patients tend to keep asking the same questions over and over, despite your answering them several times.
NEUROLOGIC IMPAIRMENT: This may occur may as a paralysis to one side of the body, difficulty with balance (walking), coma, or unequally dilated pupils. This is an indicator of severe injury and increases the likelihood of EPIDURAL or SUBDURAL HEMATOMA (internal bleeding).

Points for Monitoring Acute Head Injury

Even though your head injury is not serious enough to require a hospital stay, one must watch for the following signs and symptoms that could signal complications:

Increased drowsiness
Difficulty waking (have a family member or friend wake you every 2 hours the first night)
Slowing heart rate
Nausea and vomiting
Continuing or worsening headache
Stiff neck
Bleeding or fluid coming from the ears or nose
Weakness in arms or legs
Seizures
Blurring of vision
Slurred speech
Problems with memory
Clumsiness
Restlessness
Irritable behavior
Confusion
Unusual sensations
Difficulty walking

Call your doctor immediately or go to the emergency room.

First Aid

Be prepared to perform the basic lifesaving measures (See Artificial Respiration)
If a casualty is unconscious as the result of a head injury, he is not able to defend himself. He may lose his sensitivity to pain or ability to cough up blood or mucus that may be plugging his airway. An unconscious casualty must be evaluated for breathing difficulties, uncontrollable bleeding, and spinal injury. (See Unconsciousness)

The brain requires a constant supply of oxygen. A bluish (or in an individual with dark skin--grayish) color of skin around the lips and nail beds indicates that the casualty is not receiving enough air (oxygen). Immediate action must be taken to clear the airway, to position the casualty on his side, or to give artificial respiration. Be prepared to give artificial respiration if breathing should stop. (See Artificial Respiration)
If the casualty is bleeding from or into his mouth or throat, turn his head to the side or position him on his side so that the airway will be clear.
Place a dressing over the wounded area. DO NOT attempt to clean the wound. DO NOT attempt to put unnecessary pressure on the wound or attempt to push any brain matter back into the head (skull). DO NOT apply a pressure dressing. (See Bleeding, Dressing)
A person that has an injury above the collar bone or a head injury resulting in an unconscious state should be suspected of having a neck or head injury with spinal cord damage. Spinal cord injury may be indicated by:
1. Lack of responses to stimuli. Starting with the feet, use a sharp pointed object--a sharp stick or something similar, and prick the casualty lightly while observing his face. If the casualty blinks or frowns, this indicates that he has feeling and may not have an injury to the spinal cord. If you observe no response in the casualty's reflexes after pricking upwards toward the chest region, you must use extreme caution and treat the casualty for an injured spinal cord.
2. Stomach distention (enlargement). Observe the casualty's chest and stomach. If the stomach is distended (enlarged) when the casualty takes a breath and the chest moves slightly, the casualty may have a spinal injury and must be treated accordingly.
3. Penile erection, A male casualty may have a penile erection, an indication of a spinal injury.

CAUTION

Remember to suspect any casualty who has a severe head injury or who is unconscious as possibly having a broken neck or a spinal cord injury! It is better to treat conservatively and assume that the neck/spinal cord is injured rather than to chance further injuring the casualty. Consider this when you position the casualty.

Call your doctor immediately or go to the emergency room if you are unsure!

Keep the casualty warm.
Treat for Shock
Seizure: It is important that you know how to care for the person when he has a seizure. Seizures can happen any time, anywhere.
- If the person loses consciousness, try to prevent or break the fall.
- Turn the person onto one side.
- Loosen any tight clothing around the neck. Any object in the immediate area that could cause injury, such as hard or sharp objects, should be removed.
- Do not put anything in the person's mouth, including your fingers. (There is no danger of swallowing the tongue.)
- Let the person lie on one side until the seizure is over. Explain what happened and where he or she is.
- If the person has been injured or has another seizure right away, call the doctor.
- The person may be groggy and confused after the seizure. Stay with the person and call the doctor immediately.

Warning

DO NOT forcefully hold the arms and legs if they are jerking because this can lead to broken bones.
DO NOT force anything between the casualty's teeth--especially if they are tightly clenched because this may obstruct the casualty's airway.
Maintain the casualty's airway if necessary.
DO NOT attempt to remove a protruding object from the head.
DO NOT give the casualty anything to eat or drink.

Apply a Dressing to a Wound of the Forehead/Back of Head

Remove the dressing from the wrapper.
Grasp the tails of the dressing in both hands.
Hold the dressing (white side down) directly over the wound. DO NOT touch the white (sterile) side of the dressing or allow anything except the wound to come in contact with the white side.
Place it directly over the wound.
Hold it in place with one hand. If the casualty is able, he may assist.
Wrap the first tail horizontally around the head, ensure the tail covers the dressing
Hold the first tail in place and wrap the second tail the opposite direction, covering the dressing
Tie a nonslip knot and secure the tails at the side of the head, making sure they DO NOT cover the eyes or ears

Apply a Dressing to a Wound on Top of the Head

Remove the dressing from the wrapper.
Grasp the tails of the dressing in both hands.
Hold it (white side down) directly over the wound.
Place it over the wound
Hold it in place with one hand. If the casualty is able, he may assist.
Wrap one tail down under the chin, up in front of the ear, over the dressing, and in front of the other ear.

WARNING Make sure the tails remain wide and close to the front of the chin to avoid choking the casualty.
Wrap the remaining tail under the chin in the opposite direction and up the side of the face to meet the first tail
Cross the tails, bringing one around the forehead (above the eyebrows) and the other around the back of the head (at the base of the skull) to a point just above and in front of the opposite ear, and tie them using a nonslip knot.